Working Diagnosis:
Bilateral sensorimotor radial mononeuropathies of unknown clinical significance.

Treatment:
Neurologic consultation for concerns of possible underlying diffuse neuromyopathic process was sought. No further workup was advised, and no etiology was ascertained. The patient is participating in a physical therapy program to address his strength deficits.

Outcome:
The patient continues to engage in his typical daily routines without functional limitation. Interval follow-up to monitor for progression has been advised.

Author's Comments:
The insidious onset of the patient�s painless weakness and his marked atrophy suggests against an acute compressive neuropathy as can be seen from prolonged operative positioning. His history of end-stage renal disease and subsequent immunosuppressive therapy following his transplant could be contributing factors to his clinical presentation; however, an underlying diffuse length dependent neuropathy was not identified on electrodiagnostic testing. The unexplained presence of upper motor neuron findings was the most concerning aspect of this patient�s case. The correlation, if any, with his bilateral sensorimotor radial mononeuropathies remains unclear. Nonetheless, ongoing monitoring and further work-up is indicated. This may include interval electrodiagnostic evaluation with comparison to his initial study.

Editor's Comments:
This is an interesting case presentation in a patient with possible medical comorbidities. Electromyography showed important abnormalities and in-office ultrasound was also helpful to visualize the effected muscles. Future monitoring may help to elucidate a clear etiology.

References:
Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 2nd ed. Elsevier Saunders; 2013.
Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 3rd ed. New York City: Oxford University Press; 2001.
Perotto A. Anatomical Guide for the Electromyographer. 5th ed. Springfield: Charles C. Thomas - Publisher, Ltd.; 2011.
Preston DC, Shapiro BE. Electromyography and Neuromuscular Disorders. 3rd ed. Elsevier; 2013.

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